“We will do whatever it takes to make Medicare sustainable … If we don’t, with an ageing population, we will find ourselves in 10 or 20 years with a system that will collapse under its own weight.”
Peter Dutton, Minister for Health, The Australian November 27
With things in the world as they are, two things to celebrate, and Australian health care reform.
First, something really great: the women of Elcho Island mentioned a couple of posts ago succeeded in their crowdfunding campaign, and can now put in place their plan to address some of the nutrition and health issues that contribute to chronic preventable disease in their own lives and families, under their own community leadership.
In the same week, our Federal government—the government that currently has care of the Australian public health system on our behalf—outlined Cunning Plan B for their own bit of crowdfunding.
The plan now is to reduce the amount of funding to GPs by $5 per visit, an amount that GPs can either choose to pay for themselves or shift onto patients. This saving to government will be still not be invested back into Medicare itself, anywhere, because it’s still going to be harvested into a national medical research fund. That’s the crowdfunding part.
There are some other modest improvements in the new copayment proposition—especially the sudden insight that pathology collectors who spend all day working alone drawing blood in centres that say NO CASH ON PREMISES can’t actually collect cash on those premises.
And plans to make it mandatory for GPs to collect a co-payment from people under 16 or on concession cards have also been parked. As Health Minister Peter Dutton put it to leading Australian television journalist Leigh Sales this week, the focus has narrowed to people who could pay more, but don’t:
And we believe the people on higher incomes, people in your situation or mine, that we do ask a $5 co-payment, but that we haven’t mandated it.
OK, let’s not muck around here. People in either Peter Dutton’s situation or Leigh Sales’ situation aren’t reference points for the general Australian population, income-wise. So this remark deserves a bit of attention.
Because this is still a health policy shift that is not primarily designed to improve health outcomes. As furious GPs and community health organisations across Australia have been pointing out, the impact on lower income users and already vulnerable communities will continue to be far more serious than on anyone like Peter Dutton or Leigh Sales.
The National Aboriginal Community Controlled Health Organisation, for example, put it bluntly that this is still a proposal to defund the services that are trying to fix Australia’s existing problems of health equity:
“Aboriginal people are not overusing services, they are underusing them. Adding a financial barrier like a co-payment will not help reverse this trend.
“To close the gap there needs to be every incentive in place to get Aboriginal people to have check ups, to see their doctor, to attend their follow up appointments and attend to their health needs.
“The co-payment undermines universal health care and targets the wrong end of the system. It is simply poor health policy.”
If it’s not good health policy, what is it? Apart from funding the hypothetical Australian cure for cancer, Cunning Plan B isn’t even really aiming to fix a current health funding problem, so much to raise fears about system load in the future that the minister insists we should prepare for now. (This is from a government relentlessly selling prosperity in the present because even “what might happen in 16 years time” is too far ahead to imagine in terms of climate impact. So there’s that.)
But there’s something else going on with all this price signalling, that’s not at all subtle, and is much more interested in the dog-whistling of the past than any risks posed by the future. Governments commonly use price signalling in a disciplinary sense, to stop people doing something. Taxes on alcohol and tobacco fall into this category. Price signalling in relation to GP visits is an attempt to reframe healthcare needs as part of a generalised state of moral co-morbidity, interacting with other symptoms of individual failure to shape up to the demands of being a model citizen in a growth-focused economy.
It’s this idea of health as something that you fix by not visiting the doctor that hitches the GP co-payment to other measures being proposed in the current reform climate, and it’s why Australian higher education really needs to study the language of responsibility versus entitlement in which it’s being haggled over in public. In other words, it’s a huge clue to an effort to turn Australia back towards a time when we celebrated individuals and their ambitions over the wellbeing of their communities, and lived with ourselves by stigmatising those for whom the playing field was a mess of potholes from the start.
But we don’t necessarily think this way any more. Doubts creep in. The vision of people crashing their boats on our shores and drowning right in front of us, and the terrible conditions under which we then hold them indefinitely along with their kids, and people around the world shattered by trying to hold their families together in the face of unimaginable catastrophe just because they are where they are, and the total mess of climate change that even the biggest of polluters are rapidly trying to fix, and people all over the place taking to the streets in protest—all these things have made a difference to the way we think about who has what.
The result is that we haven’t reacted as expected to the reform program before us. As new Guardian columnist Jason Wilson (that’s the second piece of good news) put it so well this week in an outstanding piece on the current effort to put lipstick on the budgetary pig:
But another problem with “resetting” is that the current crop of Liberal MPs – a much more right wing collective than even the Howard majorities were – can’t really comprehend the belief that their budget measures were unfair. Despite Abbott’s well-known Catholicism, he shares the secular-Calvinist presuppositions that animate his party, and provide the core belief of the English-speaking right: namely, that just as the rich deserve their wealth, so do the poor deserve their fate.
Code-phrases like “personal responsibility” express the belief that those who have no job, cannot provide for their own healthcare expenses, or cannot fund their own retirement lack virtues that more successful people possess. Economic values – efficiency, the necessity for “price signals” to deter the undeserving – merely give it a contemporary gloss. It’s possible to stoke the outrage of a minority of Australians with talk of dole bludgers and queue jumpers, but the failure of Abbott’s attacks on the most vulnerable shows that Australia is not at heart a Calvinist nation.
I think he’s right; this is a government that simply cannot stop itself from reaching for the ideological condiment when they’re serving up reform. That’s why we have an out of the blue mention of “six minute medicine” in this policy, for example. It’s a healthcare myth that’s been around for a long time and has already been debunked, but it’s back now because it’s an attempt to smear general practitioners as a whole, to whisper to us that without government regulation they’ll shuffle us all out of the door as quickly as possible, before whisking away to the golf course.
It’s the worst kind of insinuation designed to break down trust between GPs and their patients, to tell us that the government is on our side as consumers, and the people to whom we’ve entrusted our health are not. This is the reality of “whatever it takes” healthcare reform: it’s sly, divisive, and unconvincing, and I can’t imagine how tough it must be to suddenly be the target of it.
So this is really an end of year thank you to the GP who takes care of me as a public health cancer patient and looks after my whole family, and to all her GP colleagues and their professional staff. We are so grateful for everything you’ve done for us.
Hang in there.